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U.S. Office of Personnel Management
Insurance Services Programs

Letter No. 2004-07 (a)

Date: June 30, 2004

     Fee-for-service [4]   Experience-rated HMO [5]   Community Rated [6]

SUBJECT: 2005 Technical Guidance and Instructions for Preparing HMO Benefit and Service Area Proposals

Enclosed are the technical guidance and instructions for preparing your benefit and service area proposals for the contract term January 1, 2005 through December 31, 2005. The guidance and instructions are in four parts:

  • Part One: Preparing Your Benefit Proposal

  • Part Two: Preparing Service Area Changes or a Re-designation as Mixed Model Plan

  • Part Three: Benefits for HMOs

  • Part Four: High Deductible Health Plans (HDHP), Health Savings Accounts (HSA), and Health Reimbursement Accounts (HRA)

Please refer to our annual Call Letter (Carrier Letter 2004-04) dated April 19, 2004, for policy guidance. Benefit policies from prior years remain in effect.

Please send us your current benefits packages no later than May 14, 2004,andyour complete proposal for benefits, clarifications, and service area changes no later than June 1, 2004, (see Part One: Preparing Your Benefit Proposal). Your proposal should include the corresponding language that describes your proposed changes for the brochure. You do not need to send your fully revised 2005 brochure by June 1.

Your OPM contract specialist will negotiate your 2005 benefits with you and finalize the negotiations in a closeout letter. Please send an electronic version of your fully revised 2005 brochure to your contract specialist within five business days following the receipt of the closeout letter or a date set by your contract specialist.

We will send you brochure printing specifications, electronic graphics, and the OPM authorization block for the cover, along with your approved brochure text file. In August, we will send you a brochure quantity form, shipping labels, and other related open season instructions.

As a reminder, each year we assess carriers' overall performance. We take into consideration your efforts in submitting benefit and rate proposals on time and your accurate and timely production and distribution of brochures.

We look forward to working closely with you on these essential activities to ensure a successful Open Season again this year.

Sincerely,



Frank D. Titus
Assistant Director
   for Insurance Services

 

Enclosure


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